Effective treatments for severe obesity are particularly needed in racial/ethnic minority populations. Rates of severe obesity are as high as 36% for middle-aged non-Hispanic black women compared to 16% for their white counterparts in the U.S. Even with multi-component lifestyle interventions, only 50% of studies show 5% weight loss (considered clinically meaningful), and most participants gain back at least half of this lost weight over 18?30 months. These outcomes have led to the development of surgical treatments for severe obesity. When compared to diet and exercise, bariatric surgery results in much higher weight loss over a period of 24 months (75% vs. 11%). Research on bariatric weight loss outcomes among racial/ethnic minorities is limited. What evidence does exist suggests that black patients consistently lose less weight than whites over 2?3 years of follow-up. The evidence for differences between Hispanic and white or black bariatric patients is equivocal. Hispanic patients have been shown to lose more, less, or the same amount of weight as non-Hispanic black and white patients. Across studies, the disparities in % total weight loss vary from less than 2% to 10%. This variability is twice as much as the amount of weight loss considered clinically meaningful. We propose to address evidence gaps in the literature by extending the work done by our team during the Bariatric Experience Long-Term (BELONG) study which addressed how self-reported behavioral, psychosocial, and perceived environmental factors predicted weight loss over 3 years following gastric bypass and sleeve. Patients (n = 1,975) were 41% Hispanic, 17% non-Hispanic black, and 37% non-Hispanic white. The proposed study will expand the work of BELONG by incorporating: 1) A focus on weight regain during 3-5 years after surgery; 2) measures shown to contribute to health disparities in severe obesity (vigilant coping style and internalized racism); and 3) innovative qualitative methods (photo-elicitation and ethnography) to understand the patient experience. IMPACT: Results will help design patient-centered, culturally appropriate post- operative care programs so that all patients achieve the maximum benefits from this highly effective treatment. We propose the following study aims: AIM 1: Determine how environmental (social, physical); healthcare system; and patient psychosocial and behavioral factors, and health status contribute to racial/ethnic disparities in bariatric weight loss and regain after 5 years. AIM 2: Gain a deeper understanding of weight loss and regain for different races/ethnicities 5 years after surgery using qualitative methods. EXPLORATORY AIM: Explore the interaction of race/ethnicity and bariatric procedure type on weight loss and regain after 5 years.